MUS, PPS services and IAPT integration into NHS primary care - what's happening across the UK?

[Dx Revision Watch]

Thanks for keeping thread active.

Very tied up with other stuff at present; no response from V Deary, but will chase when less busy.

Enjoy (if you've not already seen it)

(with hat tip to Dr Marc-Alexander Fluks)

http://www.nihr.ac.uk/blogs/doing-what-is-right-in-a-controversial-field/5370

NIHR Blog Doing what is right in a controversial field
Esther Crawley https://t.co/z9v483LcBG

 

[MeSci]

bedding with matching valances - Esters Chaefer

Ugh!

 

[trishrhymes]

More good news! The NHS will now not only cure all out diseases with CBT or Behavioural Activation ( a special Devon-based therapy......don't be jealous ) , but they are going to give us spiritual guidance too. (cast an eye on the bottom line..........oh joy!......what lucky bunnies we are! )

Funny (not) how they keep using the magic word bio-psychosocial, then focus entirely on the psycho bit.

They are determined to stop us having our bio- bits investigated. Far too complicated. And expensive.

Throwing in spiritual is a new and ominous trend. Obviously treating my spirit is cheaper than my body.

Never mind that the end result may be that spirit is all that's left of me.

 

[SamanthaJ]

"Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community." - Nye Bevan

Found that quote in an old notebook this morning. Would love to know what Bevan would make of all the above. You could be forgiven for thinking that medical care will no longer be available for certain conditions or certain people, but they can't actually say that so dress it up in psychobabble.

 

[NelliePledge]

What on earth is .GP valency for a special nest of patients.................'????

is nest a technical term of some sort

if not it is alarmingly close to alluding to rats nest

 

[NelliePledge]

Nottingham University Hospital hospital based ME/CFS service is being replaced by community based service.

I have no information about whether this will be through combining with existing community services or through open procurement. Obviously the latter leaves it open to bids from existing IAPT generic CBT providers.


Commissioners decisions announced after engagement campaign ends

Thank you for providing feedback about the NUH service review and the proposed changes to some services.

Commissioners have listened and following patient and clinician engagement can now announce the decisions of the NUH Service review.
In 2016, the Greater Nottingham Clinical Commissioning Groups (CCGs) reviewed 30 services at NUH. For the majority of these, the recommendation was to remain at NUH, some with an updated specification.

However, commissioners also identified some services and proposed that these could be delivered in a community setting, closer to patients’ homes , providing better value to the local NHS and improved outcomes for patients.

After going through the patient and clinician feedback process, service changes have been reviewed and final proposals were agreed in Collaborative Commissioning Congress and considered at each of the three CCG’s Governing Bodies.

The recommendations were approved on Friday 10 February 2017 and are below:

Services which will remain with NUH

Brain Injury and Neuro-Assessment
Conservative Management of Renal Patients (this will be integrated with the dialysis home visiting service)
Services which will be delivered in the community through either open procurement or integration with existing community services (from July 2017)

Pain Management and Back Pain Service - patients will still receive injections in line with NICE guidelines - which might take place in NUH or in the community dependent on clinical requirements
Integrated Dietetics Service – across community and acute care (where required care will still take place in the hospital setting).
Chronic Fatigue Syndrome Service
Home visiting service for patients with Motor-Neurone Disease (patients will still be under consultant care)
Geriatric Day Care/ Medicine Day Care/ Complex Rehab - following patient feedback, this service specification will include a separate annex for Parkinson's disease patients. Engagement is also ongoing with this cohort of patients.
Dr James Hopkinson, Clinical Lead, Nottingham North and East CCG says: “Patient, public and clinician feedback was always going to be integral to our commissioning decisions and we’re pleased we received such a huge response from patient and professionals via patient groups, our website and patient experience team.

“As a CCG, listening to our communities and our patients is critical. We have been happy to do that, and have made adjustments to our plans based on feedback, along with the feedback from a wide range of clinicians.

“We are now confident that the decisions we have taken represent the best way forward for the delivery of these services, whether that be in the community, in a hospital, or in a combination of the two.

“This process illustrates how important the patient voice is, and how we must all work together to plan for the future of healthcare provision in Nottinghamshire.

“More information will be available in the next couple of weeks including updated specification summaries. Thank you to all the patients who participated. We’re happy to have listened to what you have told us and have taken into consideration the issues you have raised. "

 

[Dx Revision Watch]

Nottingham University Hospital hospital based ME/CFS service is being replaced by community based service.

I have no information about whether this will be through combining with existing community services or through open procurement. Obviously the latter leaves it open to bids from existing IAPT generic CBT providers.

Commissioners decisions announced after engagement campaign ends...

Thanks for the update re the Nottingham CFS service, NelliePledge.

For anyone new to the thread, there were several earlier posts re the recomissioning of the Nottingham CFS service, including:

http://forums.phoenixrising.me/inde...ening-across-the-uk.48710/page-19#post-805159

http://forums.phoenixrising.me/inde...ening-across-the-uk.48710/page-19#post-805175

 

[Dx Revision Watch]

Don't think we have had this one posted already:

http://pchealthcare.org.uk/sites/pc...on-centered_care_of_mus_delegate_brochure.pdf


One Day Symposium
The Person-Centered Care of Medically Unexplained Symptoms
28 September 2016

St George’s, University of London UK
Delegate Brochure

European Society For Person Centered Healthcare
CauseHealth Project
St George´s, University of London UK

----------------------------


I have just had cause to yet again correct (via Twitter) an erroneous statement on classification nomenclature by Prof Helen Payne.

In this April 2015 Pathways2Wellbeing presentation:

http://researchprofiles.herts.ac.uk..._final_public_lecture_edgehill_april_2015.pdf

in Slide #13, under heading "Other terms [for MUS]"

Professor Payne states:

Other terms

Undifferentiated somatoform disorder only need to have 1 persistent (> 6 months) symptom (DSM-4) totals 79% of MUS in Primary Care Lynch et al (1999)

Somatisation disorder multiple physical symptoms unexplained by known medical condition (after full investigation) (DSM-4) totals: 1% primary care

Pain disorder

Symptom Distress Disorder is most likely term to replace above terms in new DSM-5 -associated with distressing somatic symptoms and marked health anxiety

------------

I have pointed out to Prof Payne that:

a) The DSM-5 published in May 2013 - two years earlier than her presentation.

b) The name of the DSM-5 working group for this section of disorders was the "Somatic symptom disorder working group".

c) The working group had reached consensus over the preferred disorder term, "Somatic symptom disorder" quite early on in the development process. The first public review and comment period for the DSM-5 draft was released in February 2010, with proposed disorder name, "Somatic symptom disorder." When DSM-5 published in May 2013, "Somatic symptom disorder" was the approved term. There never was a "Symptom Distress Disorder" considered for the new DSM-5 disorder construct.

d) The DSM-5 construct "Somatic symptom disorder" abandons distinction between medically explained and unexplained symptoms. DSM-5 "SSD" can be applied to "excessive" distress in response to chronic symptoms associated with general medical conditions, eg cancer, angina.

It surprises me, though perhaps it shouldn't, that an academic hawking dance and clay therapy for "MUS" and for CF, CFS, ME, IBS, FM etc and pitching this university spin off to secondary and primary care practitioners and to IAPT service providers could have failed to have missed the considerable media and academic coverage of the launch of the DSM-5 in early 2013.

I have provided her with links for journal papers and commentaries on the Somatic symptom disorder construct I co-authored with Prof Allen Frances, in 2013.

It serves to reinforce that many academics evidently struggle to distinguish between DSM-5's SSD, ICD-11's BDD, Fink et al's BDS/BDD, Goldberg's proposed BSS, some that aren't in use, and any other permutation of

somatic
bodily
symptom
distress
stress
disorder
syndrome

you can conjure.

 

[Dx Revision Watch]

https://www.theguardian.com/society...iverted-to-balance-nhs-books?CMP=share_btn_tw

Money earmarked for mental health diverted to balance NHS books

Letter from finance chief Paul Baumann says contingency of £800m will be used to offset hospital overspends

Ministers have been accused of breaking their promises on mental health after £800m earmarked to improve services was diverted to shore up hospitals’ finances etc

 

[Countrygirl]

 

[MeSci]

or brainwashing.

 

[Valentijn]

As if Oxford wasn't broad enough for them to spin their bullshit with it, now they want to get even broader and include different diseases. If claiming to cure multiple diseases is the hallmark of quackery, they're making an institution out of quackery by getting funding for research into arbitrarily combined diseases.

 

[Molly98]

They can f**k right off and shove it where the sun don't shine.

So now there are specific diagnostic criteria for MUS and it is being treated as if it is a disease in its own entirety?

Was the world always this full of people who invent and talk such BS.
I mean, Crawley, White, Wessely, Trump, Farage to name put a few recently, they take BS to another level, and what makes it worse and frightening there are people who believe it and fall for it hook line and sinker, without questioning.

Is there some brainwashing drug given to employees of the NHS disguised as a vaccine or something?

What happened to logic intellect and reasoning in the NHS?

How can a diagnosis criteria for an illness be that it is a non-illness ( in their eyes)

La La land or what, this stuff is beyond madness and way-way-way beyond common sense.

 

[Countrygirl]

Must just share with you.........I have just completed a several page survey from NHS England seeking my opinion on the care I receive from the NHS for my conditions. They say it is to help the local NHS improve!

I have completed it.............problem is I have been truthful:

added quotes like (GP)...'we regard people with ME with more contempt than we do people with depression' (from GP who was outspoken as he feared he had the disease he didn't believe in himself and was fearful of the contempt he would endure )

................and in hospital...........'once the staff here know you have a diagnosis if ME you won't be treated 'kindly'...............'

Dare I send it?

Will I disappear one dark night?

It is ready for the post box.

 

[Countrygirl]

They can f**k right off and shove it where the sun don't shine.

So delicately put @Molly98 .

Am pondering whether to add that gem to the NHS survey. It does rather encapsulate my opinion.

 

[Countrygirl]

http://www.dailymail.co.uk/health/article-4332866/Why-doctors-t-dismiss-symptoms-mind.html


What @Molly98 said above.

For patients who have no obvious physical cause for their symptoms, trying to get a diagnosis or effective treatment can be a nightmare.

It's a common problem: in as many as one in five cases, doctors find no explanation for a patient's symptoms or for their severity.

Though the symptoms are real, patients can end up being told it's all in their mind.

This will ring all too true for many with conditions such as chronic fatigue, fibro-myalgia (characterised by widespread pain and fatigue), irritable bowel syndrome, unexplained chest pain or interstitial cystitis (not caused by infection).

Read more: http://www.dailymail.co.uk/health/a...rs-t-dismiss-symptoms-mind.html#ixzz4bxlMj8ub
Follow us: @MailOnline on Twitter | DailyMail on Facebook

Not only do these problems, known as functional disorders, cause misery, but they cost the NHS a fortune.

Treating medically unexplained symptoms cost £3.1 billion a year, more than stroke or heart disease.

But research suggests these different diagnoses are all types of a single illness, bodily distress syndrome (BDS) — a new condition that's just been included in the draft of the next World Health Organisation's International Classification of Diseases, the diagnostic bible for doctors.

So according to the Daily Mail: CF aka CFS aka ME is now reclassified by the WHO as BDS. Really????

 

[AndyPR]

Good to see Janet, @Rose49 , commenting on what she thinks of this article. Additionally, I found you can up or down vote comments with out signing in.

 

[trishrhymes]

What @Molly98 said, with amplification and applause.

I note that they are not claiming to cure anything, not even to improve the lives of the patients in any way.

Behaviour modification is the aim - ie brainwashing patients to:

a) fill in questionnaires saying they feel better
b) stop visiting their GP so often.

If they achieve both of those, job done.

 

[A.B.]

Behaviour modification is the aim - ie brainwashing patients to:

a) fill in questionnaires saying they feel better
b) stop visiting their GP so often.

Alternatively: alienate the patient so much they never want to have anhthing to do with the medical system again. Job done.

 

[Countrygirl]

What @Molly98 said, with amplification and applause.

I note that they are not claiming to cure anything, not even to improve the lives of the patients in any way.

Behaviour modification is the aim - ie brainwashing patients to:

a) fill in questionnaires saying they feel better
b) stop visiting their GP so often.

If they achieve both of those, job done.

Nearly right @trishrhymes You forgot the other major factor: saving money. A major objective.